Posted by undopaminergic on May 27, 2008, at 21:53:56
In reply to Re: Suggestions for non-benzo anxiolytics PLEASE.. » undopaminergic, posted by Molybdenum on May 26, 2008, at 20:42:19
>
> just found a thermometer. My temp is exactly 38C.
>That's a bit high. I would almost certainly have a headache at that temperature.
>
> I did a little research on opioids and there does seem to be potential for a promising new class of combo anti-depressant + anxiolytics to be explored.
>
> I admit this site is a bit flaky sometimes but here goes anyway: http://opioids.com/jdtic/antidepressant-anxiolytic.html
>
> I couldn't find JDTic for sale anywhere, so I guess I'm a few years to early for that. ;)
>JDTic and other selective antagonists of the kappa-opioid receptor will be useful additions to the therapeutic arsenal.
At this point, naltrexone and buprenorphine are the major available options for kappa-antagonism, and of these, buprenorphine is greatly preferable since it is more potent, and because naltrexone also blocks the mu-opioid receptor - an action that is is detrimental, as the mu-receptor is responsible for beneficial effects, such as enhanced release of dopamine in the nucleus accumbens.
>
> My BP is 135/92. That's not bad for me. I have been 150/110 in the past. I've been taking Candesartan Cilexetil for about a year as an antihypertensive. My GP blamed the venlafaxine for the rise in blood pressure. So day 4 of moclobemide seems to be going OK. :)
>Mirtazapine and methylphenidate are likely to contribute as well, and to a lesser extent, so is modafinil. Have you tried atenolol or other beta-blockers? They are mainly used as antihypertensives, but some people find them to have some anxiolytic effects.
>
> I take your point about sedation & cyproheptadine. *doh* :) I just assumed it might produce sedation into the next day - which I really don't need.
>That has never been a problem for me, perhaps because I rarely get out of bed as long as I'm feeling sedated. I certainly would not use cyproheptadine if I wanted to sleep 8 hours or less, which does happen from time to time, for example if I have an appointment. However, it should be remembered that my days are also longer than those of most other people - usually around 24 hours or more.
> The real problem with cyproheptadine for me was reading at Wiki that "Cyproheptadine is an antihistaminic and antiserotonergic agent. It acts as a 5-HT2 receptor antagonist and also blocks calcium channels."
>
> I'd be worried that this might mean it's antihistaminic properties may work to undo the mechanism of modafinil. That would be a tragic waste..!
>Yes, but keep in mind that mirtazapine is a much more potent antihistamine than cyproheptaidne, and it has a much longer half-life. In fact, some sources (see Dr. Gillman below) claim that it's the most potent antihistamine on the market...
> Also, the antiserotonergic aspect so necessary as an antidote to serotonin syndrome would I am sure, negate the "S" aspect of my SNRI venlafaxine.
>Only to a slight extent. The 5-HT2 serotonin receptors are usually regarded as detrimental to mental health, and not only cyproheptadine and mirtazapine, but also the majority of antipsychotics block it.
> Plus my mirtazapine works by blocking presynaptic alpha-2 adrenergic receptors that inhibit the release of NE and serotonin.
>By blocking your alpha2-receptors, there's also a good chance that it's impairing your working memory and raising your blood pressure and heart rate.
However, mirtazapine's blockade of 5-HT2-receptors may be protecting you from serotonin syndrome, so that's cool. As long as you're taking mirtazapine, cyproheptadine is probably of limited usefulness to you, but I think it would be a good idea to keep it available just in case a future need of additional 5-HT2-blockade arises. I think it's pretty cheap too.
By the way, check out Dr. Ken Gillman's site:
http://www.psychotropical.com/He's an Australian psychiatrist, and an expert on MAOIs and serotonin syndrome. You may be especially interested in his articles on mirtazapine, venlafaxine, moclobemide and some other drugs. Is North Queensland close to where you live?
poster:undopaminergic
thread:830647
URL: http://www.dr-bob.org/babble/20080519/msgs/831523.html